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F BUSINESS CERTIFICATE # y <br /> '1 THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE y� I 7 <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hund d an�Sec of the General Laws, as amended, the <br /> undersigned hereby declar:11—M <br /> e(s) tthh�at`a business uunder the title ofI� <br /> Business Name/DBA: 1 — J�II LS ]�� �!Corporation Name: <br /> is conducted at Business L ocation r7Q OLat CS—ROLL) Commercial—Residential <br /> Business Mailing Address: <br /> phaa <br /> I k <br /> Business Type: Business Telephonc:�4 <br /> New Renewal I Homc Phone: Email Address- <br /> by the following named persons: <br /> Owner Nam <br /> Owner_ er ence ` �� <br /> �U i � j1�"1'�Co J� r�JI U��Cr — I `� Q <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> i� n � � C ,n_ Cru - 17q <br /> gn ire o tl rized agent. **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> tta <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts / <br /> BARNSTABLE ss (( DATE S 3v f 2 it <br /> 11 <br /> Personally appeared before me the above-named I&A-VI S Sr-NJOrJkAI&A Land made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so I g as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed r" n <br /> • Notary Public <br /> SEAL <br /> Commi 'ares-- <br /> oowtotawEattt of <br /> My Comtel 0mb0= <br /> OCIOW211,0111, <br />